Provider Demographics
NPI:1760525422
Name:RXD PHARMACY OF PA INC
Entity Type:Organization
Organization Name:RXD PHARMACY OF PA INC
Other - Org Name:RXD OF MINERSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-577-4577
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108
Mailing Address - Country:US
Mailing Address - Phone:856-858-9292
Mailing Address - Fax:856-858-7286
Practice Address - Street 1:245 SUNBURY ST
Practice Address - Street 2:
Practice Address - City:MINERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17954
Practice Address - Country:US
Practice Address - Phone:570-544-4758
Practice Address - Fax:570-544-3308
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RXD PHARMACY OF PA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412391L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007841990001Medicaid
PA3942148OtherNCPDP
PAPP412391LOtherSTATE LICENSE
PAPP412391LOtherSTATE LICENSE
PAAR9710523OtherDEA